by Linsey Blair

Individual & Couples Psychotherapist & Psychosexual Counsellor

Erectile problems are the most common male presentation in sex therapy and psychological ED is normally easy to treat. However it isn’t easy to make the first step and book an appointment with a sex therapist so here are some common questions and answers, which might help you out or at least persuade you to get the help you need.

Why can’t I get an erection?

Okay… my first question is can you get an erection in any situation?

Often men who come to me with erectile disorder can get an erection in masturbation, but not with their partners. If this is the case, there might be anxiety or relationship difficulties that are playing into the ED.

Men also self-diagnose with ED when their erection is not hard enough to penetrate or when they don’t get spontaneous erections as easily.

Our bodies change as we age and our hormones change in long term relationships and in paternity. It might be that you now need more foreplay to get fully aroused and this can be a good thing. If you slow sex down and heightening the sensuality (lubricant will help with this) you might find that this is all your penis needs to get fully erect.

Can’t I just take a tablet?

Sure you can. Men get prescribed Viagra at the drop of a hat for physical and psychological erectile problems, but this is a pity because Viagra is often not necessary and then they start to rely on it simply for the placebo effect. If you can get an erection in one situation and not the other, you do not need Viagra. Think carefully about it before you take it and please discuss it with your partner because his or her needs might be different than yours.

Also remember that Viagra does not cause desire and if you are overly anxious or there are relationship difficulties then it won’t work.

So what should I do?

Don’t panic about losing your erection. It is normal for the erection to come and go about 3 times in foreplay. If you lose your erection when you are reaching for the condom, don’t worry, just continue the foreplay. Sometimes the second or third erection can be stronger than the first one.

What tends to happen in ED is that men (and their partners!) panic when the erection goes the first time and this shared anxiety interferes with arousal so as no amount of stimulation will get the erection back.

What? You mean my thinking I have ED is giving me ED?

Yes! If you think you have a problem with erections, then in the foreplay you are worrying about whether you’re going to get an erection. You are touching your partner with your mind on your penis; thinking ‘is it hard’, ‘when will it be hard’, ‘why isn’t it hard?’

Worrying about your penis is not sexy and nobody can get aroused under pressure. ‘ED’ becomes a self-fulfilling prophecy.

Fine. What now?

In psychosexual therapy we can give you some exercises that you can do by yourself in masturbation and then with your partner. They are designed to relieve anxiety and get the sexiness back into your sex. Come and talk to us.

But this doesn’t apply to me. I can’t get an erection even when I masturbate.

Do you get a morning erection? Or wake up with an erection in the night? If so these are good signs that everything is working okay and anxiety could still be a component. However, you need to go to your GP because there are medical reasons for ED like heart disease and diabetes. It is important to get this checked out, even if it is just to get it ruled out.

There are also medical treatments and prescription drugs that will impact your erection ability, and these can be thought about with a sex therapist. Equally some surgical procedures and illnesses can leave men impotent and sometimes the sexual side effects have not been discussed with the medical professional and so they come as a surprise.

Does it mean my sex life is over if I can’t get an erection?

No. It doesn’t. It means that it will be different.

There will undoubtedly be loss for you and your partner, but it certainly is not over. I have worked with men who will never be able to get an erection and following treatment they have told me the sex they have now is more intimate than it has ever been. Remember penetration is usually the end of sex, not the beginning, and your partner does not get aroused just from penile penetration.

There are devices like the vacuum pump and surgical interventions that can also help with physiological erectile disorder, but I would recommend thinking about these routes and what they involve in sex therapy with your partner.

Appointments

You can read more about Linsey Blair’s background and experience here. If you would like to book an appointment with Linsey you can call the clinic on 091 727777 or get in touch via the contact page.